Imaging – MRI and X-Ray

X-Ray or MRI scans being held up by medical physicians

Imaging with MRI and X-Ray

tablet with skeleton of hand

Diagnostic Imaging Services

Coastal Orthopedics is pleased to offer state-of-the-art diagnostic imaging services for our patients, including digital x-rays, MRI, and arthrograms.

Digital x-rays are superior to traditional film x-rays because they provide larger, clearer, color-enhanced images that result in a more accurate diagnosis. The newly implemented digital imaging plates allow for faster and easier positioning, which can lead to less stress for injured or ill patients. X-ray is available at each of our clinic locations.

Our MRI facility is equipped with a state-of-the-art Siemens 1.5T magnet that has been refined to the specifications of our physicians and produces the best images around. Upon completion of the scan, images are sent directly to our server and are available to your Coastal Orthopedics physician at any one of our four facilities. This is a convenient feature that is only available when scanned at Coastal Orthopedics. To learn more about MRIs and arthrograms, click on the appropriate questions below:

MRI is short for Magnetic Resonance Imaging. MRI is an advanced technology that lets your doctor see internal organs, blood vessels, muscles, joints, tumors, areas of infection, and more – all with excellent clarity and without the use of x-rays, surgery or any pain. MRI is very safe; in fact, it makes use of natural forces and has no known harmful effects. It’s important to know that MRI will not expose you to any harmful radiation.

An MRI machine creates a magnetic field, sends radio waves through your body and then measures the response with a computer. This creates an image or picture of the inside of your body that is much clearer than can be obtained with most other methods.

MRI can provide very early detection of many conditions, so treatment can be more effective, accurate and rapid. The excellent quality of MRI images can also provide the best possible information if surgery is required. If there is an abnormality, MRI can show exactly where it is, its size and what tissues are involved.

In most cases, you can just stick with your normal, everyday routine – no special preparation is needed. You can eat and drink your usual diet, work or play sports (unless you have an injury) – and take any prescription medications you need. However, there may be some circumstances in which you’ll be given specific instructions to follow before the exam. These will be given to you by your doctor, or by the MRI booking clerk at the time the MRI is arranged.

Yes. Because the MRI machine uses a strong magnetic field, which will move objects made of iron or steel, let your doctor know if you have:

  • A pacemaker
  • Aneurysm clips
  • Cochlear implants
  • A neuro-stimulator
  • Steel surgical staples or clips
  • An implanted drug infusion device
  • Any implant made partially or wholly of iron or steel
  • Also, if you’re pregnant, let the doctor know.

Metal objects not made of iron or steel can interfere with the exam – so don’t bring any of the following into the examination room (a secure place to store your valuables will be provided):

  • Coins
  • Jewelry
  • Watches
  • Keys
  • Dentures or partial plates
  • Hearing aids
  • Magnetic waves can also erase the code on bank cards and credit cards, so don’t bring your credit or bank cards into the MRI examination room. They should be stored in the locked safe we provide to you.

Finally, you may be asked to change into scrubs that we will provide for your comfort and convenience during the examination.

There are many varieties of MRI exams. Depending upon the area being scanned, the set up of the room, and your position may be different. To begin the exam, you will lie down on the scan table. When the machine starts to work, you’ll hear some very loud knocking sounds. These sounds occur whenever the MRI pictures are being taken. You will be provided with earplugs or headphones to help block out the knocking sounds.

In any case, although it’s noisy, an MRI exam is completely painless. The only thing you must do is HOLD STILL. When you take a picture with a camera, your subject must keep still or the picture will come out blurry. It’s the same with an MRI machine. If you move, the scans will be out of focus – and you may have to repeat the exam.

If necessary, you may be injected with a solution called a contrast agent or “dye”. This allows the radiologist to see the image more clearly. MRI contrast agents typically have few or no side effects, and the injection likely will just feel like a slight pinch. You may be asked to give your consent to this injection, at which time a more detailed explanation about the contrast agent will be given to you by our MRI technologist.

The exam can last from 30 minutes to about an hour.

Well, you may feel very well rested since you’ve just been lying on a table and doing absolutely nothing! (In fact, some people even fall asleep during the exam.) Other than that, you’ll feel perfectly normal and can go back to your everyday activities. If you have further questions about your MRI exam, the MRI technologist or your doctor will be glad to answer them.

Your referring physician will receive a report within 48 hours of your exam. Your physician will be able to access the images “on-line” via the internet immediately after your exam. You can make an appointment with your referring physician to go over your results.

An arthrogram is a diagnostic test which examines the inside of a joint (e.g. shoulder, knee, wrist, ankle, hip) to assess an injury or a symptom you may be experiencing.

First, you will have images taken of the joint on the MRI scanner. This will allow the radiologist to see what the joint space looks like prior to any contrast being injected.

You will then go to have the contrast medium injected into the joint space. The contrast (or “dye” as it is sometimes called) outlines the soft tissue structures in the joint (e.g. ligaments and cartilage) and makes them clearer to see on the images or pictures that will be taken of the joint. This is usually done using fluoroscopy. Fluoroscopy uses X-rays to transmit moving images onto a screen to guide the placement of the needle containing the contrast medium. The exact technique will vary from doctor to doctor and also depend on the joint being injected.

This is then followed by going back to the MRI scanner. While an MRI without the use of contrast medium can provide information on the soft tissue structures, using contrast medium with MRI (an Arthrogram) may provide more information about what is wrong with the joint.

Generally, no specific preparation is required. It may be best to wear comfortable clothing with easy access to the joint being examined. Please see the FAQ section on MRI as to how to prepare for an MRI in general.

The Arthrogram injection itself usually takes about 15 minutes. You may then have to wait a short time before having the MRI scan performed. The subsequent MRI scan may take about 30 minutes depending on the joint and the number of scans that have to be done. You should allow approximately 2 hours from arrival at the office.

Generally, you will be asked to lie down and the skin over the joint being examined will be cleaned with an antiseptic solution. Following this, a local anesthetic may be injected into the skin to numb the area where the contrast medium will be injected. You may feel a slight stinging sensation.

Then using X-ray for guidance, a needle will be placed into the joint and after ensuring the needle is in the right place the contrast medium will be injected into the joint.

The injection may be accompanied by a feeling of fullness in the joint but should not be painful.

The contrast medium used depends on the exact nature of the Arthrogram and the specialist doctor performing the Arthrogram. This is generally iodinated contrast medium. This will be followed by a very dilute mixture of MRI contrast (gadolinium) together with sterile saline (mildly salty water). Following the injections, you will be taken to back to the MRI scanner, where more images of the joint will be taken.

Many people have a sore joint as the reason for the examination. Most patients feel some mild to moderate increase in soreness in the joint for 24-48 hours following the injection. The joint will then return to feeling the way it was before the examination. If you are having your knee, ankle or hip injected you may want to have a driver.

Arthrography is a very safe procedure and complications are unusual.

The most serious complication is an infection of the joint. This is usually caused by organisms from the patient’s skin being transferred into the joint and for this reason, the procedure should not be carried out if it is broken or infected skin overlying the joint.

The risk of infection is not precisely known but the best available information suggests that it is in the order of 1 in 40,000 people having the test.

Occasionally people may be allergic to the contrast medium that is injected, and this most commonly results in a rash but may be more serious. The risk of minor reaction (e.g. hives) has been reported in 1 in 2,000 having the test. More serious reactions appear to be very rare.

Complications of gadolinium contrast medium used in an MRI have not been reported in the very small amounts used in arthrography.

The injection of contrast medium into the joint makes the subsequent scan more sensitive in detecting damage to the internal structure of the joint.

Some common reasons for an Arthrogram in addition to the scan are:

  • In the shoulder – where the joint is unstable or if an ultrasound or plain MRI has not shown a suspected tendon tear
  • In the hip – to show any tear of the cartilage labrum (or rim of the joint)
  • In the wrist – to show any tear of the small ligaments of the wrist

There are many other individual situations where your referring doctor may feel that the additional information obtained by an Arthrogram may help to determine the best course of treatment.

One of Coastal Orthopedics’ pain physicians will perform the arthrogram, injecting the contrast medium into the joint. The radiologist will be the one responsible for analyzing the scans and preparing a formal report of the findings, which is sent to the doctor who referred you for the test.

Either a nurse or a radiographer may assist the physician in the arthrogram. The radiographer is responsible for taking the pictures in the arthrogram.